Surgical instruments for minimally invasive surgical procedures

ABSTRACT

The present invention provides a group or kit of surgical instruments for use in minimally invasive surgical procedures. In one embodiment, the invention is an instrument with a generally central longitudinal axis and a generally toroidal surface generally transverse to the axis, wherein the convex portion of the surface does not extend beyond a line parallel with the longitudinal axis along an outer diameter of the instrument, and the surface has a continuous edge having a first end at a shoulder and a second end at the shoulder and spaced from the first end; in another embodiment, the instrument has a working end with a generally longitudinal axis, the working end defined by a generally curved surface along the longitudinal axis, wherein the curved surface has a concave portion and a convex portion, and wherein the working end has a generally flat tip; in another embodiment, the surgical instrument includes a working end having a generally central longitudinal axis and a surface generally transverse to the axis, wherein the surface is generally spatulate and oval, and wherein the surface is set at a selected angle relative to the axis; and in yet another embodiment, the surgical instrument comprises a straight pin for being placed into bone, the pin having a sharp tip, a number of spaced steps generally adjacent to the tip, marks adjacent to the steps, and an end opposite the tip for hammering.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.09/601,288, filed Jul. 28, 2000 U.S. Pat. No. 6,520,953, which was adivisional of U.S. patent application Ser. No. 09/308,700, filed May 21,1999, now U.S. Pat. No. 6,096,026, issued Aug. 1, 2000, which claims thepriority of PCT application PCT/US98/19751, filed Sep. 22, 1998, and ofU.S. provisional patent application serial No. 60/059,440, filed Sep.22, 1997, all of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to instruments for use in medical procedures.More particularly, this invention relates to a set of surgicalinstruments substantially for dissection and retraction in minimallyinvasive surgical procedures such as laparoscopy and mini-laparotomy.

2. Background Information

Surgical tools are commonly used in minimally invasive surgicalprocedures, such as mini-laparotomy, laparoscopic or thoracoscopicsurgery, to provide mechanical handling of tissue. For example, duringsurgery on or adjacent to the spine the surgeon should have clear accessto the desired intervertebral discs or vertebrae for purposes ofdiscetomy, vertebrectomy, spinal decompression, or placement of fusiondisc devices, prosthetics, or other hardware. Surgical tools may be usedfor dissection and/or retraction of blood vessels or other bodilytissues to provide clear access to the desired area. In some spinalprocedures, the surgical entry point is on the abdominal side of thepatient's body, so the tools must provide clearance so that the entirediameter of the abdominal cavity may be traversed for performance of thesurgical procedure.

In some minimally invasive surgical procedures, such as laparoscopic orthoracoscopic procedures, one or more trocars typically penetrate and/orare maintained or mounted in the wall of the body cavity to provideaccess for the surgical tools during the procedure. The trocars may formor act as ports into the body cavity for insertion and manipulation ofsurgical instruments. Some surgical instruments, particularly those withsharp tips or edges, are inserted and moved to a desired workinglocation in the body in hollow tubes or sheaths to reduce the risk ofharming other blood vessels or organs during traversal of the body. Avideo camera may be mounted on a laparoscope which is passed through atrocar port for visualization of the procedures in the body cavity on amonitor. Alternatively, an X-ray or other visualization system may beused to view the procedure, including the position of instrumentsrelative to the surgical site, on a suitable monitor.

Generally it is desirable to reduce the number of trocar ports usedduring a surgical procedure to reduce trauma to the patient. For thisreason, a plurality of surgical tools, including tools dedicated to aspecific function, adapted to be inserted through a trocar are preferredso that blood vessels, tissue, and the area of the surgical proceduremay be manipulated through a small number of trocar ports or through amini-laparotomy incision.

A variety of tools, such as retractors, forceps, graspers, sutureneedles, and pins, currently exist and may be available for use duringabdominal or thoracic procedures. Such tools, however, have certaindeficiencies when minimally invasive access methods are used. Oneproblem with available surgical tools is that they are not properlyshaped for optimal harmless manipulation of blood vessels and otherbodily tissue during laparoscopic or thoracoscopic procedures. Anotherproblem with some surgical tools which might be appropriately shaped isthat they do not fit through the tubes or trocars, so it can bedifficult to traverse the body to reach the desired working location.The typical trocar is approximately 11 to 12 or less millimeters indiameter, and the hollow tubes therein are of approximately the samediameter. Some surgical tools have working ends of greater than 12millimeters in length, and it would be difficult or impossible to insertthese tools through typical trocars and tubes.

A need exists for surgical tools and methods which reduce potentialtrauma associated with surgery, including minimally invasive surgicalprocedures, and which aid the surgeon in manipulating blood vessels andtissue during surgical procedures. More specifically, a need exists forsurgical tools for dissection and retraction that are shaped to allow asurgeon to manipulate blood vessels and other bodily tissue withoutharming the patient. The tools should also be properly shaped to performspecific functions or procedures conveniently and with minimal risk tothe patient, yet they should be usable through typical trocars, ports orshort incisions (e.g., incisions of the type used in mini-laparotomy).

SUMMARY OF THE INVENTION

The present invention provides instruments for use in surgicalprocedures. In one embodiment, the instruments of the present inventioncomprise a kit of instruments well-suited for use in minimally invasivesurgical procedures, particularly such procedures involving or conductednear the spine. The kit includes at least one or more of the retractorsdescribed herein, one or more of the dissectors described herein and oneor more of the pins described herein. It is anticipated that the kitwould be available to surgeons through, for example, typical hospital orclinic supply arrangements, in the form of a sterilized prewrappedpackage of one or more of the instruments or selected embodiments of theinstruments.

Each of the instruments comprising the kit is an embodiment of thepresent invention. One embodiment, the retractor(s), comprises a workingend having a generally central longitudinal axis and a surface generallytransverse to the axis, the surface being defined by a generallytoroidal shape having a concave portion and a convex portion, theconcave portion having a selected degree of openness, wherein the convexportion of the surface does not extend beyond a line parallel with thelongitudinal axis along an outer diameter of the working end adjacent tothe surface, and the surface has a continuous edge having a first end ata shoulder and a second end at the shoulder and spaced from the firstend. This embodiment of the invention may further comprise a shaftcoupled to the working end for handling the surgical instrument. Theworking end and shaft may be unitary (i.e., formed as a single piece),they may be permanently coupled or connected, or they may be separablyjoined.

In another embodiment, the retractor comprises a working end having agenerally longitudinal axis, the working end being defined by agenerally curved surface along the longitudinal axis, wherein the curvedsurface has a concave portion and a convex portion, and wherein theworking end has a generally flat tip. Again, the working end may beformed as one piece with a shaft or handle, it may be permanently joinedto a shaft, or it may be separably joined to a shaft.

Another embodiment, of the invention, the dissector(s), comprises aworking end having a generally central longitudinal axis and a surfacegenerally transverse to the axis, wherein the surface is generallyspatulate and oval, and wherein the surface is set at a selected anglerelative to the axis. In this embodiment, the surface may also be offsetin reference to a shaft.

Another embodiment of the invention, the pin(s), comprises a straightpin for being placed or driven into bone, the pin having a sharp tip anda number of steps generally adjacent to the tip, as well as circularmarkings or etchings adjacent to each step separated at a 1 cm distance.Along the length of the pin, from the tip, the pin increases generallyincrementally in diameter with each step, and has a first end oppositethe sharp tip for hammering. In this embodiment, the invention mayfurther comprise a hollow guide tube for removably receiving the pin asthe pin is moved to the site of use, the pin being longer in length thanthe guide tube.

An advantage of the instruments of the present invention, particularlyin kit form, is that they facilitate performing minimally invasivesurgical procedures, particularly spinal procedures, wherein eachinstrument is well adapted for a particular function or manipulation ofa particular tissue.

For example, the retractors are well suited for manipulation of tissues,for example, tissue adjacent or immediately adjacent to the spine, thecommon iliac artery and vein, segmental vessels or the cystic duct. Thedissectors are well suited for manipulation tissues such as themid-sacral and segmental blood vessels or the cystic, and the pins maybe driven into bone, including vertebrae, to support or hold tissue(s)in a desired position during a surgical procedure.

Another advantage of the instruments of the present invention,particularly the retractors, is that they include a working end at leasta portion of which is radiolucent, i.e., permeable to radiation, wherebya surgeon may have an improved visualization of other devices in useduring a procedure and examined or displayed on an imaging system.

Another advantage of the instruments of the present invention,particularly the retractors and dissectors, is that they have smoothcontinuous edges, smooth working surfaces, and smoothly rounded edgesand tips to reduce potential trauma to delicate tissue.

Other features and advantages of the surgical instruments of the presentinvention will become more fully apparent and understood with referenceto the following description and drawings, and the appended claims.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of one embodiment of the surgical instrument inits entirety;

FIG. 2 is a side view of the working end of the embodiment of FIG. 1;

FIG. 3 is a top view of the working end of the embodiment of FIG. 1;

FIG. 4 is a side view of another embodiment of the surgical instrumentin its entirety;

FIG. 5 is a side view of the working end of the embodiment of FIG. 4;

FIG. 6 is a top view of the working end of the embodiment of FIG. 4;

FIG. 7 is a side view of another embodiment of the surgical instrumentin its entirety;

FIG. 8 is a side view of the working end of the embodiment of FIG. 7;

FIG. 9 is a top view of the working end of the embodiment of FIG. 7;

FIG. 10 is a side view of another embodiment of the surgical instrumentin its entirety;

FIG. 11 is a side view of the working end of the embodiment of FIG. 10;

FIG. 12 is a top view of the working end of the embodiment of FIG. 10;

FIG. 13 is a cross sectional view of the working end of the embodimentof FIG. 10;

FIG. 14 is a top view of another embodiment of the surgical instrumentin its entirety;

FIG. 15 is a side view of the working end of the embodiment of FIG. 14;

FIG. 16 is a second side view of the working end of the embodiment ofFIG. 14;

FIG. 17 is a top view of a working end of the embodiment of FIG. 14;

FIG. 18 is a top view of a second working end of the embodiment of FIG.14;

FIG. 19 is a top view of another variation of the embodiment of FIG. 14;

FIG. 20 is a side view of the working end of the variation shown in FIG.19;

FIG. 21 is a cross sectional view of the embodiment of FIG. 19;

FIG. 22 is a second cross sectional view of the embodiment of FIG. 19;

FIG. 23 is a view of a pin in its entirety;

FIG. 24 is an enlarged view of the end of the pin of FIG. 23; and

FIG. 25 depicts a hollow tube to be used in conjunction with theembodiment of FIG. 23.

FIG. 26 depicts an embodiment of the present invention wherein a groupor kit of at least some of the embodiments of the instruments of thepresent invention is provided for use in performing a minimally invasivesurgical procedure.

DETAILED DESCRIPTION

The accompanying Figures depict embodiments of the surgical instrumentsof the present invention, and features and components thereof. Withregard to means for fastening, mounting, attaching or connectingcomponents of the present invention to form the instruments as a whole,unless specifically described otherwise, such means are intended toencompass conventional fasteners such as machine screws, machinethreads, seals, snap rings, clamps, rivets, nuts and bolts, toggles,pins and the like. Components may also be connected adhesively, bysoldering or friction fitting, or by welding or deformation, ifappropriate. Unless specifically otherwise disclosed or taught,materials for making components of the present invention are selectedfrom appropriate materials such as metal, metallic alloys, natural orsynthetic materials, plastics and the like, and appropriatemanufacturing or production methods including casting, extruding,molding and machining may be used.

Any references to front and back, right and left, top and bottom, upperand lower, and horizontal and vertical are intended for convenience ofdescription, not to limit the present invention or its components to anyone positional or spacial orientation.

A number of instrument embodiments of the invention are shown in FIGS.1-25, and FIG. 26 depicts that a selected number of the embodiments orselected embodiments may be assembled, gathered or provided as a kit orgroup 3 of instruments for performing a surgical procedure, particularlya procedure such as a minimally invasive spinal procedure. In general,the instruments of the invention may be used as surgical instruments fordissection and retraction in minimally invasive, laparoscopic, or otherprocedures. The embodiments of the present invention are shaped to aidin dissection and retraction in minimally invasive procedures, and arewell-suited for use in spinal procedures. In these procedures, the entrypoint for the procedure (typically through trocar ports) may vary,although it is commonly done through the abdominal incisions of variouslengths. The procedure is then viewed on a monitor connected to either acamera attached to a magnifying device (such as a laparoscope orthoracoscope) which is inserted in a trocar port or through a systemusing X-ray or other appropriate imaging techniques. Directvisualization through a mini-incision may also be used.

a. Retractors

FIGS. 1-9 show three variations of one embodiment of the invention.FIGS. 1, 4, and 7 show a surgical instrument 10 comprising a working end12 and a shaft 14. The working end 12 has a generally centrallongitudinal axis and a surface 16 generally transverse to the axis. Thesurface 16 has a generally toroidal shape having a concave portion 18and a convex portion 20, as best illustrated in FIGS. 2, 5, and 8. Theinstrument 10, or particularly the working end 12 can be made from anyvariety of rigid material, such as hard plastic. Preferably, the workingend 12 or a substantial portion of it, is radiolucent (i.e., partly orwholly permeable to radiation, such as X-rays) whereby it is adapted toreduce interference or to not interfere with a surgeon's ability to seeother devices examined on an imaging system or displayed for viewing thesurgical procedure. The working end or a portion of it may be maderadiopaque for some applications.

The concave portion 18 of the surface 16 has a selected degree ofopenness which may vary widely. FIGS. 2, 5, and 8 show concave portions18 of varying degrees of openness. The degree of openness of the concaveportion 18 may be selected to promote ease of use of the surgicalinstrument 10, particularly in the manipulation of blood vessels andbodily tissue, and more particularly tissues adjacent to the spine,without harming them. The working end 12 of the embodiment of FIGS. 1-9,and particularly the surface 16, should be appropriately shaped fordissection and retraction of large blood vessels, such as the commoniliac artery and vein, or similar generally tubular or cylindricalstructures during surgical procedures. As can best be seen in FIGS. 2,5, and 8, the surface 16 of the instrument 10 defined by the concave 18and convex portions 20 defines a gently rounded, “soft” edgedscoop-shaped working surface. The face 19 of the concave portion 18 ofthe surface 16 preferably is flat from the edge 22 on one side of theconcave portion 18 to the edge 22 on the other side. In other words, astraight line may be formed along the face 19 of the concave portion 18along an axis perpendicular to the longitudinal axis. The thickness ofthe surface 16, which is the distance between the concave portion 18 andthe convex portion 20, may vary, as illustrated by the differentembodiments in FIGS. 2, 5, and 8.

The surface 16 is also defined in that it has a smoothly roundedcontinuous edge 22 having a first end 24 at a shoulder 26 and a secondend 28 also at the shoulder 26 and spaced from the first end 24. Theedge 22 defines the working surface 16 of the invention. For instance,on one side of the edge 22 lies the concave portion 18, which is theside primarily used for manipulation of bodily tissue. The convexportion 20 is on the other side of the edge 22. The area between theconcave 18 and convex portions 20 defined by the edge 22 may be eitherflat or rounded. The edge 22 is preferably not a sharp edge, but ispreferrably blunt so that it will not harm bodily tissue during use. Theshoulder 26 is a ring of slightly increased diameter around the circulararea of the working end 12 just below the surface 16. The shoulder 26defines the portion of the working end 12 where the concave 18 andconvex portions 20 begin, and hence where the scoop-shaped workingsurface begins. The surface 16 of the invention should be smooth so thatit does not harm bodily tissue when in use. Similarly, the tip 32 of theworking end 12 may be rounded and blunt to prevent harm to bodilytissue.

In the embodiments of the invention shown in FIGS. 1-9, the concave 18and convex portions 20 of the working end 12 do not extend beyond thediameter of the shaft 14. The concave 18 and convex portions 20,similarly, do not extend beyond a line parallel with the longitudinalaxis along an outer diameter of the working end 12 below the shoulder26. Because the convex portion 20 does not extend beyond the diameter ofthe shaft 14 or working end 12, it does not interfere with the passageof the working end 12 under the deep side of a blood vessel during useof the surgical instrument. This feature of the invention also may beimportant because it allows the surgical instrument 10 to be inserted ina hollow tube, port, or typical trocar (not shown in Figures) forinsertion into the body cavity. A tube or sheath may be used along withthe instrument 10 so that the working end 12 does not harm the tissue asit traverses the body cavity to reach the area of manipulation. Thewidth of the surface 16 of these embodiments is determined as thefunctionally optimal while still fitting through a trocar port andhollow tube (approximately 11-12 millimeters in width). An increasedwidth of the surface 16 prevents harm to blood vessels during use of theinstrument 10. The width of the surface 16, therefore, may be the sameas the diameter of the circular portion of the working end 12 below thesurface 16 and near the shaft 14.

As shown in the Figures, particularly FIGS. 3 and 6, in one embodimentthe surface 16 of the invention includes a neck portion 30 of decreasedwidth than the remainder of the surface 16. The width of this neckportion 30 may vary so that the invention may be used in varioussituations to manipulate body tissue, such as segmental vessels, and thecystic duct during cholecystectomy.

The length of the working end 12 of the invention may vary. In oneembodiment the working end is approximately 2 to 4 inches in length,with the surface 16 of the working end 12 approximately 1 to 2 inches inlength. The shaft 14 may be of any appropriate length and should be longenough to traverse the body cavity, such that it may be inserted in oneend of the body to manipulate tissue at the other end of the bodycavity. In one embodiment the shaft 14 is approximately 10 to 20 inchesin length. The diameter of the shaft 14 and of the working end 12 shouldas wide as for physician comfort and ease of use while still fittingthrough the desired trocar port. In one embodiment, during the use of atrocar port of 12 millimeters in diameter, the diameter of the shaft isapproximately 11 millimeters so that it will fit through trocar port.

In one embodiment, the shaft 14 may be removably connected to theworking end 12. As shown best in FIGS. 3, 6, and 9, the end of theworking end 12 opposite the surface 16 may contain male threads 34 tomate with female threads 36 in the shaft 14. Other methods forconnection known to those skilled in the art may also be used. In thedepicted or a similar manner, the working end 12 is easily removablefrom the shaft 14 so that a small number of shafts 14 may be used with alarger number of working ends 12. Alternatively, in another embodiment,the working end 12 may be permanently joined or coupled to the shaft 14by methods known to those skilled in the art, or the working end 12 andshaft 14 may be formed as a single piece. The end or a portion 38 of theshaft 14 opposite the working end 12 may be gnarled or textured to aidin gripping the shaft 14, and may be larger in diameter than theremainder of the shaft.

Another embodiment of the invention is shown in FIGS. 10-13. In thisembodiment, the working end 12 is defined by a generally curved surface50 along the longitudinal axis. In other words, the curvature in thisembodiment is in a direction that is generally perpendicular to thecurvature of the embodiment in FIGS. 1-9. The curved surface 50 has aconcave portion 52 and a convex portion 54, as can best be seen in FIG.13. The surface 50 also has a generally flat tip 56. The curvature ofthe surface 50 may vary. This embodiment of the surgical instrument 10has a smooth continuous edge 58, which defines the boundaries of theworking face 60 of this embodiment. This continuous edge 58 extends fromthe flat tip 56 along both sides of the surface 50 and meets at theouter diameter of the working end 12 at a length of approximately 1 to 2inches from the flat tip 56. The face 60 of the invention slantsgradually outward toward the outer edge 62 of the working end 12 from aninitial depth at approximately the center of the working end 12 near theflat tip 56. The width of the face 60 gradually decreases with distanceaway from the flat tip 56.

The length of the working end 12 of this embodiment of the invention mayvary. In one embodiment the working end 12 is approximately 2 to 4inches in length, with the surface 50 of the working end 12approximately 1 to 2 inches in length. The shaft 14 of this embodimentof the invention may have approximately the same characteristics as theembodiment shown in FIGS. 1-9 and described above. The working end 12 inthis embodiment, therefore, may be permanently or removably coupled tothe shaft 14.

b. Dissectors

FIGS. 14-22 show another embodiment of the invention. In this embodimentof the invention, the working end 12 has a generally longitudinal axisand a surface 70 that is generally transverse to the axis. The surface70 may be generally spatulate and oval, as best seen in FIGS. 17 and 18,and may be set at an angle α relative to the axis. In one variation ofthis embodiment, the angle α is between 0 and 90 degrees. In theembodiment shown in FIGS. 15 and 16, for instance, the angle α isapproximately 20 to 45 degrees. This embodiment may prove helpful inslipping underneath certain bodily tissue when the angle of the workingend 12 relative to the shaft 14 is important in accessing certain areas,such as mid-sacral and segmental blood vessels and the cystic duct. Inanother variation of this embodiment, shown in FIGS. 19-22, the angle αis approximately 90 degrees.

The surface 70 of this embodiment may have substantially flat upper andlower surfaces 72, 74, respectively. The width 76 and thickness of thesurface 70 in this embodiment is generally thin. In one embodiment, forinstance, the width 76 of the surface is approximately 2 to 5millimeters. This embodiment of the invention may be useful in slippingunderneath certain bodily tissues to separate and remove it from nearother tissue. More specifically, this embodiment of the inventionpromotes and facilitates separation (dissection) of blood vessels fromoften tightly adherent tissue, such as the mid sacral and segmentalvessels and other types of tissue deemed appropriate by the surgeon,such as the iliolumbar vein, a branch of te left common iliac vein. Thisembodiment may be used for dissection of vessels, such as the cystic oruterine arteries, prior to anticipated occlusion with clips and/orsuture, or coagulation with an electrocautery device.

In the embodiment of the invention shown in FIGS. 14-18, the surface 70is offset in reference to the shaft 14. The surface 70 in thisembodiment may have a continuous edge 78. with a selected degree ofcurvature on a first side 80 and a substantially straight second side 82opposite the first side 80. As can best be seen in FIGS. 17 and 18, thecurved first side 80 of the edge 78 causes the surface 70 to be offsetfrom the shaft 14. The straight second side 82 does not extend beyondthe width of the working end 12 or shaft 14 adjacent to the surface 70.The curved first side 80, however, may extend beyond the width of theshaft 14 or working end 12 adjacent to the surface 70. The straight side82 of the surface 70 may be ideal for placement against some bodilytissue, while the surface 70 is slid between different tissues toseparate the tissues with the curved side 80 of the surface 70. Thisembodiment of the invention may assist in the detachment and separationof blood vessels from adjacent attachments or from themselves. Anexample is their use in the separation of the left common iliac arteryand vein from each other during exposure of or access to the L₄₋₅ discduring anterior spinal fusion. This embodiment is also helpful in theseparation of the sympathetic chain from the vertebrae duringlaparoscopic or thoracoscopic sympathectomy. In one embodiment, the ovalor spatulate-shaped surface 70 has a diameter of approximately 5 to 10millimeters, but this size may be varied as long as its use inmini-laparotomy or other minimally invasive surgical procedures is notimpaired.

Much like the other embodiments of the instruments 10 of the presentinvention, the working ends 12 of the embodiments of FIGS. 14-22 areconnected to a shaft 14. The working ends 12 may be removably orpermanently connected to shafts 14. As best illustrated in FIGS. 15, 16,and 20, the end of the shaft 14 near the working end 12 may be tapered.The taper of the shaft 14 allows for better vision of the laparoscopicfield or laparoscopic image as seen on the monitor. The end of the shaft14 opposite the working end 12 may be gnarled (the gnarls arerepresented by numeral 38 in FIG. 14) for grip. The diameter of theshaft 14 in this embodiment may generally vary, as long as it isconvenient for use in minimally invasive surgical procedures.

c. Pins for Retraction

FIGS. 23 and 24 show another embodiment of the invention. Thisembodiment is a straight, substantially rigid pin 90 for being placedinto hard tissue. The pin 90 has a sharp tip 92 and a number of steps 94generally adjacent to the tip 92. The pin 90 increases incrementally indiameter with each step 94, and may be of a generally round shape. Thepin 90 may also have etched or superficial marks 96 provided along thelength of the pin 90. The etched marks 96 in the embodiment shown inFIG. 24 are in the region of the steps 94 and are approximately 1 cmapart. The diameter of the pin 90 may vary; in one embodiment it isapproximately {fraction (1/32)} of an inch near the tip 92, increasingto approximately {fraction (3/32)} or ⅛ of an inch near the outer steps94 of the pin 90. The diameter of the pin 90 should be chosen to allowfor hammering of the pin 90 into the bone without bending. The end ofthe pin 90 opposite the sharp tip 92 contains a blunt tip 98 that isideal for hammering. A portion of the blunt tip 98 may also containgnarls to aid the surgeon in gripping and manipulating the pin 90.

In practice, the pin 90 is hammered into bone so that it holds a bloodvessel or other tissue in a selected place during a surgical procedure.The pin 90 may be used in minimally invasive or other surgicalprocedures. The pin 90 may be used to mark specific bones or depths ofbones (such as specific intervertebral disc levels) during surgery. Theetched marks 96 and the steps 94 serve multiple purposes. The steps 94serve to inform the surgeon as to the depth of penetration of the pin 90into the bone. The steps 94 also provide a positive stop to preventinadvertent passage or hammering of the pin 90 deeper into the bone thanis desired. The etched marks 96, similarly, serve to denote the depth ofthe pin 90 from the tip 92 into the bone. In one embodiment, the etchedmarks 96 are spaced at 1 centimeter and 2 centimeter depths from the tip92. The surgeon, therefore, may easily determine the depth of the pin 90into the bone so that the surgeon does not inadvertently damage the boneor spinal cord of the patient. In one embodiment, the pin 90 is at least10 to 12 inches long so that it is long enough to traverse the diameterof the body cavity while in use.

FIG. 25 shows a hollow tube 100 to be used in connection with the pin90. The tube 100 is shorter than the pin 90. In one embodiment, the tubeis approximately 1 to 3 inches shorter than the pin 90, but this lengthrelationship may be varied as long as the tip is able to be retractedinto the tube and as long as it may be driven into a selected bonewithout interference. In this embodiment, therefore, the tube 100 may beapproximately 12 to 14 inches in length. The purpose of the tube is tocontain the sharp tip 92 of the pin 90 during its passage through theabdominal or thoracic cavity (or other body cavity) during surgery. Thediameter of the tube 100 should be slightly greater than that of the pin90. The tube 100 may also contain a locking mechanism 102 to lock thepin 90 in place within the tube 100 to prevent it from falling out ofthe tube and into the patient's body. The locking mechanism 102 shown inFIG. 25 is a simple screw, although any other type of locking mechanism102 known to those skilled in the art may be used. The ends of the tubemay be blunt, so that the body is not harmed by the tube, and the endsmay also contain slight bevels 104.

In practice, the locking mechanisms 102 are tightened during transfer ofthe pin 90 through the body cavity to where it will be hammered into thebone. Once there, the lock is loosened, and the pin 90 is advanced andhammered into place. If the tube 100 is longer than the pin 90, theconnection between the tube 100 and the pin 90 may be tightened and thetube 100 may then be hammered into place. Once in place, the guide tubemay rest against the bone into which the pin 90 was hammered, remainingas a pin sheath during the surgery. At the conclusion of the surgicalprocedure, the pin 90 is withdrawn so that the tip 92 lies within thetube 100, the locking mechanisms 102 are tightened around the pin 90 sothat the tip 92 is within the tube 102, and then the pin 90 and guidetube 102 are withdrawn.

While the present invention has been described with reference to severalembodiments thereof, those skilled in the art will recognize variouschanges that may be made without departing from the spirit and scope ofthe claimed invention. Accordingly, this invention is not limited towhat is shown in the drawings and described in the specification butonly as indicated in the appended claims.

What is claimed is:
 1. A set of surgical instruments for use in surgicalprocedures, comprising: (a) at least one or more retractors; and (b) atleast one or more dissectors; and (c) at least one or more pins; and (d)wherein the set of surgical instruments is sterilized and in packaging.